Curative treatment for low-grade arteriovenous malformations

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Spetzler-Martin (SM) grade I-II arteriovenous malformations (AVMs) are typically treated with microsurgery or radiosurgery.
• The role of preoperative embolization in reducing surgical risk for these low-grade AVMs is debated.

Purpose of the Study:

• To evaluate the safety and long-term functional outcomes of combined treatment for grade I-II AVMs.
• This combined treatment involves preoperative embolization followed by surgical resection or radiosurgery.

Main Methods:

• Retrospective analysis of 258 patients with SM I-II AVMs (2002-2017).
• Detailed review of endovascular procedures, embolic agents, and complications.
• Comparison of functional status using the modified Rankin Scale (mRS) pre- and post-treatment.

Main Results:

• 48% of patients presented with hemorrhage; 68% of unruptured and 59% of ruptured AVMs underwent embolization.
• Four complications (2.4%) occurred in 164 embolized patients: two hemorrhages, one dissection, one infarct.
• High cure rates (100% on angiography) and good long-term outcomes (mRS ≤ 2 in 92.5% unruptured, 88.0% ruptured) with low permanent morbidity (1.2%).

Conclusions:

• Endovascular embolization followed by microsurgical resection or radiosurgery is a safe and effective curative treatment for selected SM I-II AVMs.
• Preoperative embolization serves as a safe adjunct, improving outcomes compared to other published series.
• Patients with low-grade AVMs treated with this combined approach demonstrate favorable long-term functional results.